Individual
DR. CHARLES M BURGESS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
104 E GUNTER AVE, OPP, AL 36467-1604
(334) 493-3501
(334) 493-3502
Mailing address
104 E GUNTER AVE, OPP, AL 36467-1604
(334) 493-3501
(334) 493-3502
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3319
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000090883
—
AL
Enumeration date
10/25/2006
Last updated
07/08/2007
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